International Journal of Periodontics & Restorative Dentistry, 1/2021
Pages 135-140, Language: English
Conical retention with antirotational features (Acuris abutment) has been recently proposed for restorations of healed single implants. The conometric abutments use the retentive force of the coping-abutment system to retain the prosthetic crown without the use of cement or screws. This retentive force must be overcome to obtain detachment of the relined provisional crown in immediate restorations. The present article describes the use of digital scanning technology to virtually plan computer-guided implant placement and restoration with conical indexed abutments in postextraction sites. Importing the scan data of both matrix and patrix abutments that are seated on the definitive cast into the computer-aided design software provides a workflow to preoperatively mill a crown that perfectly fits the abutment into the postextraction site. This technique simplifies the provisional crown relining onto the conometric indexed abutment and reduces the intraoperative time.
The International Journal of Prosthodontics, 1/2021
Pages 37-46, Language: English
Purpose: To evaluate the 2-year performance of definitive implant- or tooth-supported three-unit fixed dental prostheses made of zirconia-reinforced lithium silicate placed to restore premolars and molars in clinical cases of partial edentulism.
Materials and Methods: All patients received a three-unit fixed restoration made of monolithic, hot-pressed, zirconia-reinforced lithium silicate glass-ceramic. The restoration was cemented to two natural teeth or attached to two 3.5- or 4.5-mm–diameter square threaded, gritblasted, acid-etched integrated implants with a Morse taper connection. Peri-implant pocket depth and bone and soft tissue remodeling were recorded for 2 years at each follow-up visit. Esthetic, functional, and biologic United States Public Health Services (USPHS) parameters modified by the World Dental Federation study design were assessed yearly until the final follow-up appointment. At the time of placement of the definitive restorations and at the 2-year follow-up visit, the opposing dentitions were identified by type of restoration and supporting structures.
Results: A total of 100 patients were consecutively enrolled in the period between June 2016 and July 2017, and 50 patients each received an implant-supported restoration (Group A) or a tooth-supported restoration (Group B). One (2%) of the 50 implant-supported prostheses fractured after 21 months of function. None of the other prostheses failed or became loose or detached. No significant differences involving probing levels or bone and soft tissue remodeling were found between the follow-up times. No cases of inflammation or infection of the mucosal cuff around the neck of the implants were recorded. The most common issue occurred immediately after placement of the prosthesis, when 3 patients (6%) from Group A and 4 patients (8%) from Group B asked for a modification of tooth shade.
Conclusion: Implant-supported or tooth-supported three-unit fixed dental prostheses made of zirconia-reinforced lithium silicate can be used to successfully restore cases of posterior partial edentulism. The 2-year results of this report will be studied more in depth in ongoing long-term research.
International Journal of Periodontics & Restorative Dentistry, 6/2020
Online OnlyDOI: 10.11607/prd.4796, PubMed ID (PMID): 33151185Pages e211-e227, Language: English
For decades, the histologic evidence about osseointegration and the bone-implant interface has been discussed in the literature. In this review, the effectiveness of dental implants retrieved for different causes was evaluated. A literature search was performed in databases for papers about implants retrieved from humans published by the Implant Retrieval Center of the University of Chieti-Pescara, Italy. Sixty-eight articles were selected into categories based on topics. The data indicated high level of bone-toimplant contact, lamellar bone close to the surface, roughness related to an increased bone response, organized and remodeled bone after loading, and peri-implant interfaces subjected to a continuous dynamic function.
International Journal of Computerized Dentistry, 4/2020
SciencePubMed ID (PMID): 33491928Pages 325-333, Language: English, German
Aim: The goal of this case series was to evaluate the clinical outcome at the 2-year follow-up of immediately loaded combined screw- and conometric-retained implant-supported full-arch restorations virtually planned using digital scanning technology.
Materials and methods: This series included 12 patients presenting hopeless teeth in the maxilla treated with computer-guided flapless implant placement. A total of 72 implants were inserted. All implants were immediately loaded with a complete-arch restoration supported by an intraorally welded framework. Digital scanning technology was used to virtually plan a combined screw and conometric retention of the frameworks. Clinical parameters were assessed at 1 week and at 1, 3, 6, 12, and 24 months follow-up.
Results: The survival rate after 2 years was 98.6%, as one implant failed during the osseointegration period. No major prosthetic complications were observed such as issues with mobility, unscrewed abutments, disconnected conometric copings, and prosthetic fracture. Only one patient registered the chipping of a prosthesis.
Conclusion: Based on the results of the present study, the use of combined screw and conometric retention for fixed immediate restorations properly planned using digital scanning technology seems to be a viable treatment alternative to screw or conometric retention alone for immediately loaded rehabilitations.
Keywords: conometric retention, screw-retained, fixed dental prostheses, computer-guided surgery, computer-aided implantology, 3D optical scanning
Pages 51-60, Language: German
Kürzlich wurde die schrauben- und zementfreie Retention implantatgetragener Restaurationen mithilfe einer Konus-in-Konus-Verbindung zwischen dem Abutment und einer korrespondierenden Kappe vorgeschlagen. Dieser als Konometrisches Konzept bezeichnete Ansatz dürfte zu einem Umdenken bezüglich klassischer Standards der präzisen Verbindung zwischen einzelnen Restaurationskomponenten führen, da mithilfe vorgefertigter Komponenten eine überlegene Passung zwischen dem Abutment und der Restauration erreicht wird. Hinzu kommt, dass Restaurationen dieses Typs keine Löcher aufweisen, wie sie bei verschraubtem Zahnersatz benötigt werden, und sich mit einem Kronen- bzw. Brückenentferner leicht wieder abnehmen lassen. Zudem kann der Restaurationsrand intrasulkulär platziert werden, ohne dass die Gefahr von subgingivalen Zementresten am Spalt zwischen Abutment und Gerüst besteht. Dieser Artikel fast die Grundprinzipien des neuen Konzeptes zusammen und zeigt auf, inwieweit es einen Paradigmenwechsel bei der Retention von implantatgetragenem Zahnersatz darstellen kann.
Manuskripteingang: 09.10.2019; Annahme: 07.11.2019
Keywords: Implantatgetragener Zahnersatz, Implantatkrone, konometrisch, Konusverbindung, Teleskopkrone, spaltfreie Restauration
International Journal of Periodontics & Restorative Dentistry, 3/2018
DOI: 10.11607/prd.3130, PubMed ID (PMID): 29641625Pages 363-371, Language: English
The use of the cone-in-cone connection to support definitive restorations was previously evaluated in cases involving full-acrylic resin or hybrid acrylic-resin composite prostheses. The aim of this study was to evaluate the performance of definitive fixed partial prostheses made with monolithic zirconia and supported by cone-in-cone abutments and integrated implants. Implants were placed into healed sites and fresh extraction sockets. The prostheses were placed in the posterior regions of partially edentulous patients after healing periods of 3 months. A total of 76 patients received fixed monolithic zirconia restorations splinted with cone-in-cone connections to two implants that were followed up yearly for 5 years. At each follow-up visit, peri-implant bone levels and pocket depths were recorded. Esthetic, functional, and biologic United States Public Health Services parameters modified by the World Dental Federation study design were assessed at the last follow-up appointments. The opposing dentition was categorized by type of restoration and supporting structure at the time of placement of the definitive zirconia partial restoration and at the 5-year follow-up. The treatment achieved an 88.2% success rate and a 97.4% survival rate at the 5-year follow-up. None of the prostheses became loose or detached. One fixed prosthesis (0.76%) fractured 41 months after placement. No significant difference involving peri-implant bone and probing levels between the experimental times was found. The results of this research indicated that abutment-prosthesis cone-in-cone connections were successful within the 5-year study period.
International Journal of Periodontics & Restorative Dentistry, 3/2018
DOI: 10.11607/prd.3503, PubMed ID (PMID): 29641634Pages 431-441, Language: English
The aim of this study was to analyze the degree of mineralization around nine clinically stable titanium dental implants retrieved after 2 months to 17 years for mechanical complications from five patients. The micromorphology and microchemistry of the interface bone at the coronal and apical sides of the threads were analyzed by environmental scanning electron microscope and energydispersive X-ray spectroscopy (EDX) on histologic samples. Mineralization was investigated by atomic calcium-to-nitrogen (Ca/N), phosphorous-to-nitrogen (P/N), and calcium-to-phosphorous (Ca/P) ratio evaluation (statistical analysis by two-way analysis of variance with Student-Newman-Keuls; P < .05). EDX showed higher Ca/N, P/N, and Ca/P values for the bone at the coronal side compared to the apical side of the threads in the long-term (≥ 14 years) samples. The two most significant findings were that (1) the interface bone located at the coronal side of the implant threads was generally more mineralized than the interface bone located at the apical side, and (2) the mineralization of the peri-implant bone at the interface increased over time. A higher degree of mineralization was found at 2 months in an immediately loaded implant when compared to the 2-month submerged unloaded control, likely related to the different remodeling events (coronal vs apical side of the implant threads) due to the direction of the loading forces.
The International Journal of Prosthodontics, 6/2017
DOI: 10.11607/ijp.5224, PubMed ID (PMID): 29084300Pages 553-555, Language: English
Purpose: This study evaluated the retention strength of welding caps for Ankylos standard abutments using a pull-out test.
Materials and Methods: Each sample consisted of an implant abutment and its welding cap. The tests were performed with a Zwick Roell testing machine with a 1-kN load cell.
Results: The retention strength of the welding caps increased with higher abutment diameters and higher head heights and was comparable or superior to the values reported in the literature for the temporary cements used in implant dentistry.
Conclusion: Welding caps provide a reliable connection between an abutment and a fixed prosthesis without the use of cement.
International Journal of Periodontics & Restorative Dentistry, 4/2017
DOI: 10.11607/prd.3027, PubMed ID (PMID): 28609507Pages 590-598, Language: English
Inaccuracy of computer-guided implant placement may lead to complications when combined with an immediately loaded prefabricated prosthesis. The aim of this case series was to describe the use of an intraoral welding technique to increase the predictability of immediately loaded implants supporting a fixed full-arch prosthesis after computer-guided flapless implant placement. A total of 60 Ankylos plus implants (Dentsply) with a width of 3.5 mm and a length of 8 to 14 mm were placed consecutively in 10 patients. The implants were functionally loaded using the intraoral welding technique on the day of surgery. The accuracy of guided implant placement was assessed by matching the planning cone beam computed tomography (CBCT) scans with postoperative CBCT scans. No mechanical or biologic complications were registered at the 1-year follow-up. The global coronal deviation of implant placement from the guide plan ranged from 0.25 to 2.84 mm (SD: 0.6 mm), with a mean of 1.28 mm. Average angle deviation was 3.42 degrees (range 0.38-7.82 degrees; SD: 1.52 degrees). The global apical deviation ranged between 0.36 and 3.85 mm (SD: 0.71 mm), with a mean of 1.65 mm. Despite the inaccuracy registered, this guided-welded approach allowed successful achievement of a passive fit of the full-arch prosthesis on the inserted implants the same day of the surgery and provided a high implant and prosthetic survival rate at the 1-year follow-up.
The International Journal of Oral & Maxillofacial Implants, 1/2017
DOI: 10.11607/jomi.4852, PubMed ID (PMID): 28095514Pages 37-41, Language: English
Purpose: The aims of this study were to evaluate the ability of a stepped osteotomy to improve dental implant primary stability in low-density bone sites and to investigate possible correlations between primary stability parameters.
Materials and Methods: The study was performed on fresh humid bovine bone classified as type III. The test group consisted of 30 Astra Tech EV implants inserted following the protocol provided by the manufacturer. The first control group consisted of 30 Astra Tech EV implants inserted in sites without the underpreparation of the apical portion. The second control group consisted of 30 Astra Tech TX implants inserted following the protocol provided by the manufacturer. Implant insertion was performed at the predetermined 30 rpm. The insertion torque data were recorded and exported as a curve; using a trapezoidal integration technique, the area underlying the curve was calculated: this area represents the variable torque work (VTW). Peak insertion torque (pIT) and resonance frequency analysis (RFA) were also recorded.
Results: A Mann-Whitney test showed that the mean VTW was significantly higher in the test group compared with the first control and second control groups; furthermore, statistical analysis showed that pIT also was significantly higher in the test group compared with the first and second control groups. Analyzing RFA values, only the difference between the test group and second control group showed statistical significance. Pearson correlation analysis showed a very strong positive correlation between pIT and VTW values in all groups; furthermore, it showed a positive correlation between pIT and RFA values and between VTW and RFA values only in the test group.
Conclusion: Within the limitations of an in vitro study, the results show that stepped osteotomy can be a viable method to improve implant primary stability in low-density bone sites, and that, when a traditional osteotomy method is performed, RFA presents no correlation with pIT and VTW.
Keywords: dental implants, primary stability, resonance frequency analysis, surgical technique, variable torque work